medinq.com

     EDITORIALS

 2005

        Medical Malpractice Aches and Pains

These problems arise when patients, doctors, lawyers, insurances, etc.,
abuse their respective roles. The gross national product depends on the
actual worth of the nation’s resources, be it natural or intellectual, etc.
The excessive middlemenship and cost overruns can actually destroy the
nation’s economy despite very sophisticated technology. Good example was
the Enron scandal, which caused a man-made blackout and a near-collapse
of the state of California!

Similarly, the function of health professionals, especially doctors, is to
maintain members of society in an optimal health. Excessive malpractice
costs can compromise this task. And yet, doctors’ economic ambitions
can be equally destructive. Say, a patient develops calf pain
due to artery occlusion/stenosis, which may be solved by a simple angioplasty
and at a low cost. However, the hospital may find the profits from a by-pass
surgery too tempting to advise an alternative treatment, and the patient
undergoes a mutilating procedure, ending in an amputation. It causes a
spouse of the patient (a chain-smoker) to get a heart attack. The hospital
and doctors reap considerable profit from both incidents, which may
require a long-term care as well. However, society suffers because of
loss of labor, needless expenses incurred for care of disease, which could
have been avoided, not to mention the “pain and suffering” of the
patient and her immediate family.

Now, the patient and her family with total income of, for example, $30,000.00/yr
files a suit for $50,000,000.00, which is much in excess of what they would
ever expect to make. The jury, taken aback by the dramatic story
and the persuasiveness of the trial lawyer, awards the huge reimbursement
to the family (it’s not the shirt off their skin!). The plaintiff gets her money and
30% goes to the lawyer, deservedly or not. This drives the cost of insurance
affecting all doctors, most of whom may have been hard working
and honest practitioners. Of course, the companies offering malpractice
insurance are not charitable organizations either (as they possibly should).
They are here to make a profit, and the huge jury awards give them an
excuse to jack up the premiums well beyond the reasonable limits.
The doctors leave town …

Another cost (if not corners) cutting measure was to hire 25% foreign doctors
in the hospital residency programs. These doctors were expected to leave the
country after completing their “training”. The “training” concept is frequently
used to hire cheap and expandable labor. And, of course, the nurse
practitioners, the physician’s assistants – are recently created professions
designed to cut the expense of treating the patient at the expense of the
quality of care.

In essence, we are dealing here with laws of the jungle – nature rules supreme.
In a civilized society though, apart from the effective regulations, we have right
to expect to, and rely on ethical conduct of the involved parties. Maybe a little bit
a preaching and repetitive moralizing on moderation would help? Or, do we have
to go thru a roller coaster of fall and redemption?

Imposing a cap on “pain and suffering” should not be overlooked either. Could
some simple cases be handled by caseworkers following a preset fee-schedule?
And should the jury be allowed to award someone else’s money or just determine
the liability and have the awards made based on overall availability of funds set for
this purpose and the number of expected cases calculated statistically? Ultimately,
an uninvolved and impartial party may act in a preventive manner by consulting
both the patient and doctors of the available treatment options.

( Adam Zynger)


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